Fixing care: refocusing on those who need it and those who deliver it

It is time to put the patient-to-carer relationship at the centre of this most human-faced sector—and the EU must play its part.

The collective effort to protect those most at risk from the coronavirus is unprecedented. Through changes to their everyday lives, an overwhelming majority of people are showing a commitment to putting human lives ahead of their usual comforts. 

Similarly, nursing-home workers have kept on going, through truly traumatic situations. For too many of them this effort has cost them their life. After ten of the residents she had been caring for passed away, Marie-Madeleine was among the first of these workers to succumb in Brussels—the very city where European Union decision-makers can now take decisive action. 

Today, workers across Europe are mobilising for the Global Day of Action for Care. We join them in remembering the fallen and fighting for those still on the front line.

Caring for the most vulnerable is a value that unites people across Europe. Yet, mirroring the experiences of others on the front lines, the crisis has stretched our increasingly precarious nursing homes to breaking point.

Staggeringly under-prepared

Nursing homes were staggeringly under-prepared for this crisis. Across the European Union member states, their residents have accounted for 30-60 per cent of Covid-19 deaths.

While viruses stem from nature, the factors facilitating their spread within nursing homes are products of human choices. The results of the drive towards unsafe staffing levels, chronic equipment shortages and cuts in personnel training are nothing short of a disaster. Quality of care has long been sacrificed at the altar of quantity. Corners have been consistently cut to prioritise the saving of money over the saving of lives.

These choices are symptomatic of a deeper crisis—the crisis in workplace democracy. When working people have a say over decisions in their company, they use it to ensure safety and improve their conditions. After years of undercutting each other, including for public contracts, nursing homes are among the workplaces with the worst working conditions and least receptiveness to collective bargaining.

Procurement lever

Sectoral collective bargaining gives workers the ability to drive up conditions across the whole industry and must be part of the solution. There are signs the EU is waking up to the underlying structures that suppress workers’ conditions. Just yesterday, the European Commission released the draft of the Minimum Wage and Collective Bargaining Directive. If the EU is serious about addressing the situation, decision-makers must start by requiring that public procurement—a major lever when it comes to the care sector—limits eligibility only to those companies that respect workers’ collective-bargaining rights.

Investing in care means improving staffing levels, so patients can receive the dignified care they need. Long-term care facilities with higher staffing ratios have better resident outcomes and workers are more likely to feel confident about the care they are providing. When care is rushed, residents feel dehumanised and workers report forgetting or having to omit tasks due to lack of time. Understaffing leads to high anxiety and burnout, mostly because workers fear injury to themselves and residents. 

Workers in the care sector are some of the lowest paid: many direct caregivers work at minimum wage or well below the living wage. The pandemic has revealed that our nursing homes had not provided the necessary training associated with infectious disease management. Staff often lacked the training to use personal protective equipment properly—even when this was available. 

Heavy resort to agency and temporary staff in long-term care has presented a particular challenge in terms of training. For better disease management, we need better jobs. Driving down conditions, to the extent that people need to find multiple jobs at multiple facilities to make ends meet, can no longer be an option. Decent conditions are essential for those who do this essential work.

Wealth extraction

Paralysis gripped nursing homes during the pandemic. Under-staffed, under-trained and under-equipped, they lacked any slack to adapt to the exceptional circumstances. The problem is not a lack of money. The money is there but it is being redistributed upwards—as share buy-backs, debt-servicing, dividend payments and other forms of wealth extraction.

Private-equity investors, in particular, are snapping up what they see as ‘attractive opportunities’. Typical approaches involve loading nursing homes with debt and sale-and-leaseback of the properties (as exemplified by the recently signed deal by Orpea). While the real-economy nursing-home business is burdened with these new payment requirements, the investors are allowed to extract the money and invest it elsewhere. In the worst-case scenario the nursing home will go bankrupt but these predators know that governments will be forced to step in beforehand, as they cannot let elderly people become homeless.

It is crucial that the EU targets its interventions and policies at improving care, rather than safeguarding these destructive practices of wealth extraction. These structural problems, in one of the world’s most developed regions, are manifest policy failures. As well as resulting in better resident outcomes, higher staffing ratios would lead to the creation of jobs rooted in the communities care homes serve. 

In addition, because this industry is primarily female, investing in care could reduce the gender wage gap by as much as 5 per cent. Investing in pay also reduces the need for workers to work more than 40 hours per week, leading to less burnout. Investing in decent jobs, staffing, training and equipment would align pursuit of economic recovery with improved long-term care. 

Protecting the vulnerable

Care cannot be fully explained by numbers: its physical and emotional aspects demand that we regulate in a way that protects the most vulnerable in our communities. In the EU, the creation of  a health union is being discussed. It would include stress tests on health systems and common minimum standards. These are all positive improvements—but until policies and funds can be explicitly connected to worker conditions and resident environments, there are no guarantees for those living and working in the system. 

Better working conditions are achieved through sectoral collective bargaining. By working together, unions, employers and governments can support each other to ensure decent work, as well as raising the standards of care. Workers in the sector need to be able to form and join unions. Through sectoral bargaining we can raise the bar for everyone at the same time. 

Beyond an issue for trade unions alone, improving conditions for care is increasingly recognised as an objective towards which all caring organisations, including the charitable and faith-based, are working. One easy way to do that is to redirect public procurement from incentivising companies to cut corners to driving up care quality instead.

The coronavirus recognises no borders and care needs are not fundamentally different from one country to the next. Investment combined with sectoral bargaining can ensure that care workers in all European countries, in private or public facilities, have decent working and living conditions. We have the opportunity to create a better future—a care system which protects everyone and builds a shield against the coronavirus for all.